Salt and Hypertension: Dietary Minerals, Volume Homeostasis and Cardiovascular Regulation PDF
Preview Salt and Hypertension: Dietary Minerals, Volume Homeostasis and Cardiovascular Regulation
R. Rettig D. Ganten F.C. Luft (Eds) Salt and Hypertension Dietary Minerals, Volume Homeostasis and Cardiovascular Regulation With 124 Figures and 46 Tables Springer-Verlag Berlin Heidelberg New York London Paris Tokyo R.RElTIG D. GANTEN German Institute for High Blood Pressure Research and Department of Pharmacology, University of Heidelberg 1m Neuenheimer Feld 366, D-6900 Heidelberg West Germany F.e. LUFf Indiana Univ. School of Medicine, Fester Hall108, 1120 South Drive, Indianapolis, Indiana 46223, USA ISBN-13 :978-3-642-73919-4 e-ISBN-13: 978-3-642-73917-0 DOl: 10.1007/978-3-642-73917-0 Library of Congress Cataloging-in-Publication Data Salt and hypertension. Based on a symposium held in Munich, Germany in 1987. Includes index. 1. Hypertension-Etiology-Congresses. 2. Sodium-Physiological effect-Congresses. 3. Salt in the body Congresses. I. Rettig, R. (Rainer), II. Ganten, D. (Detiev), III. Luft, F. C. (Friedrich C,), [DNLM: 1. Electrolytes-metabolism-congresses. 2. Homeostasis-congresses. 3. Hypertension-physiopathology congresses. 4. Sodium, Dietary-metabolism-congresses. WG 340S176 1987] RC685.H8S25 1989 636.1'32071 88-33669 ISBN-13:978-3-642-73919-4 (U. S.: alk-paper) This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only per mitted under the provisions of the German Copyright Law of September 9,1965, in its version of June 24,1985, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. © Springer-Verlag Berlin Heidelberg 1989 Softcover reprint of the hardcover 1st edition 1989 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product Liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. 212113145-543210 Printed on acid-free paper Preface Controversy regarding the wisdom of a high salt intake has been with us for 5000 years. In the Nei Ching, the oldest of the extant medical writings, the Yellow Emperor observed, "Hence, if too much salt is in the food, the pulse hardens, tears make their appearance, and the complexion changes". At about the same period in history, Job asked the question, "Can that which is unsavory be eaten without salt?" It is not apparent whether or not the Almighty provided a clear answer. The connection between dietary salt intake and hypertension was appreciated following the observations of AMBARD, BEAUJARD, VOLLHARD, ALLEN, and others. However, DAHL emphasized this relationship, as demonstrated by his epidemiological observations, his studies in human subjects, and his development of a genetically mediated form of salt-sensitive hypertension in rats. DAHL and his followers argued that hypertension was a disease of acculturation, or even of self-abuse. Undaunted by skeptics such as PICKERING, they suggested that if Western man would merely curtail his intake of the granular condiment, hypertension would not develop and blood pressure would not increase with age. Bucolic native societies were given as examples where such cardiovascular bliss was readily attained. Life has proved not to be so simple. The blood pressures of hypertensive man and rat did not decrease in correspondence with dietary salt reduction. The complexity of arterial hypertension was emphasized time after time, such as by the notions of salt sensitivity and salt resistance and their genetic proclivities. The intake of other electrolytes was examined and found to be important. Dietary potassium intake was identified as having an influence on vascular disease independent of blood pressure. The importance of calcium as a fundamental intracellular messenger became widely recognized. By probing not only the internal environment and the intracellular environment, but also the molecular mechanisms of contraction, relaxation, nerve conduction, and hormone release and reuptake, investigators realized the importance of other electrolytes and began to concentrate on their interactions. The role of these electrolytes has been examined in terms of cellular mechanisms, homeostasis, and metabolism. Old notions have been retested and cherished ideas are being reeval uated. The Intersalt study*, which will have been made public by the time this book is published, is an example. The purpose of this symposium was to provide a forum for controversy and discussion. An international group of investigators representing a variety of viewpoints was convened. They were invited to show their data and were then faced with the * Intersalt Cooperation Research Group (1988). Intersalt -an international study electrolyte excretion and blood pressure. Results for 24 hour urinary sodium and potassium excretion. Brit. Med. J. 297:319-328 VI Preface prospect of being cross-examined by other participants and also by members of the audience at large. Sodium, chloride, potassium, calcium, and magnesium were dis cussed. The scope of discussion ranged from epidemiological and social issues and extended to events at the cellular level. The presentations illustrated the complexity of the issues involved and the heterogeneity of this disease that we term "primary hypertension." As anticipated, no absolute consensus could be reached, although mention was made of a quote attributed to JEREMIAH STAMLER: "Two can lie in the same bed and dream different dreams." This was, perhaps a disappointment to health care policy makers and to the public, who prefer discrete variables to continuous ones, simple answers to complex ones, and preferably a recipe by which to avoid the body's ills. However, progress has been made. The area of research into the role of electrolytes and their intake in hypertension is extremely active. Much is known and is currently being applied in clinical trials around the world. Good advice for a healthy cardio vascular life is available; we have included as an appendix to this book a summary of the recommendations of the US Joint Commitee on Detection, Evaluation, and Treatment of High Blood Pressure. The experts agreed on advice accepted since ARISTOTLE: "Take nothing in excess." Moderation in intake with respect to all foodstuffs, particularly alcohol, seems wise. Adequate and balanced intake of potas sium and calcium would appear appropriate. All recognize that salt is essential to human survival, but there does not appear to be a reason to consume massive amounts of it. These notions are not new. From that perspective, the more things change the more they stay the same. It is the hope of the organizers that the following chapters submitted by the participants will give the readers a flavor of the meeting and its salient features, as well as of its scientific content. The program was a rich one, and students of the subject were well served. Heidelberg, Indianapolis, November 1988 RAINER RETTIG DETLEV GANTEN FRIEDRICH LUff Table of Contents Electrolyte and Volume Homeostasis The Phylogeny of Salt Appetite ................................................ 3 D. DENTON, M. McKINLEY, E. TARJAN, and R. WEISINGER Salt- and Volume-Regulating Systems.......................................... 12 E. RITz, J. MANN, and M. SCHMID Osmotically Activated Ion Channels in Membranes of Opossum Kidney Cells ...................................................... 23 J. VBL, H. MURER, and H.-A. KOLB Cellular Mechanisms Na+ and K+ Transport in Human and Rat Erythrocytes: Features Complicating the Interpretation of Data .............................. 35 J. DUHM Intracellular Cation Concentrations in the Pathogenesis of Essential Hypertension ...................................................... 52 W. ZIDEK Intracellular Cation Homeostasis Impairment in Primary Hypertension. . . . . . . . 61 P. MEYER Risks of Salt Depletion and Salt Excess 66 D. ELY, B. FOLKOW, and N.F. PARADISE The Neuronal Basis of Salt Sensitivity .......................................... 83 S. OPARIL, Y.-F. CHEN, R.-H. YANG, H. JIN, Q.C. MENG, E.J. CRAGOE, and J.M. WySS Neural Control of the Kidney in Hypertension ................................. 97 G.F. DIBONA VIII Table of Contents New Aspects of Steroid Hormone Control: Role of Adrenal Renin ............ 107 P.J. MULROW, E. KUSANO, K. BABA, Y. DOl, D. SHIER, and R. FRANCO-SAENZ Genetic Determinants of Salt Sensitivity Genetic Aspects of Blood Pressure Sensitivity to Sodium ...................... 121 M. H. WEINBERGER, F.C. LUFT, J.Z. MILLER, C.E. GRIM, N.S. FINEBERG, and J.e. CHRISTIAN Augmented Reciprocal a-2 and f3-2 Adrenoceptor Changes and Rise of Total Peripheral Resistance During Increase of Salt Intake in Salt-Sensitive Humans ....................................................... 128 F. SKRABAL, P. KOTANKO, A. LUEGER, B. GOEDDE, R. BALMES, M. BARENBROCK, and T. FISCHER Inherited Bimodal Traits and Susceptibility to Hypertension in Utah Pedigrees ................................................ 139 R.R. WILLIAMS, S.e. HUNT, S.J. HASSTEDT, P.N. HOPKINS, L.L. Wu, T.D. BERRY, B.M. STULTS, G.K. BARLOW, and H. KUIDA Pathophysiological Significance of Different Types of Minerals Calcium Metabolism in Spontaneously Hypertensive Rats ..................... 159 T.B. DROEKE, C. ROULLET, and P.A. LUCAS Role of Calcium in Modulating Salt Sensitivity ................................. 169 J.R. SOWERS, P. ZEMEL, P. STANDLEy,J. KRANIAK, and M.B. ZEMEL Calcium Metabolism and Arterial Pressure Regulation in Humans ............. 176 D.A. MCCARRON, E.W. YOUNG, R.D. BUKOSKI, and C. D. MORRIS Calcitonin Gene-Related Peptide-Like Immunoreactivity in Hypertension: Relation to Blood Pressure, Sodium, and Calcium Metabolism ................ 190 L.M. RESNICK, J.J. PREIBISZ, and J.H. LARAGH Importance of Dietary Sodium and Chloride for Salt Sensitive Hypertension .. 200 T.A. KOTCHEN, S. REDDY, C. GENAIN, and N. BLEHSCHMIDT Chloride as a Determinant of Salt-Sensitivity 211 T.W. KURTZ, and R.C. MORRIS Jr. Table of Contents IX High Pottassium Diets During Hypertension Reduce Arterial Endothelial Injury, Stroke Mortality Rate, Arterial Hypertrophy, and Renal Lesions Without Lowering Blood Pressure . . . . . . . . . . . . . . . . . . . . . . . . .. 218 L. TOBIAN Magnesium and Blood Pressure Regulation .................................... 235 I. GIRNDT Role of Magnesium in Blood Pressure Regulation: A Review of Studies Performed in Animals .................................... 242 A. OVERLACK,I.G. ZENZEN, and K.O. STUMPE Calcium Messenger System in Vascular Smooth Muscle ........................ 249 H. MEYER-LEHNERT and H.I. KRAMER Whole-Body Exchangeable Sodium in Cardiovascular and Endocrine Disorders ....................................................... 258 R. DE CHATEL, M. T6TH, A. TISLl~,R, I. BARNA, M. HERENDI, and M.-A. VOSSBEIN Epidemiology of Salt Consumption and Intervention Trials Blood Pressure Responses to Acute Sodium Chloride Depletion in Healthy Young Adults: The Bourbon County Study. . . . . . . . . . . . . . . . . . . . . . . .. 275 I.M. KOTCHEN, P. TAYLOR, M. McFADDEN, B. NGAI, G.P, GUTHRIE Ir., and T.A. KOTCHEN Electrolyte Intake and Hypertension in Children ....... , ....................... 283 D.E. GROBBEE, and A.A.A. BAK Salt Consumption and Salt Intervention Studies in the German Democratic Republic ................................................. 293 H. HEINE, L. HEINEMANN, W. BARTH, and H.D. FAULHABER Alteration of Sodium and Potassium Intake in the Treatment of Hypertension 300 G.A. MACGREGOR The Australian Sodium Potassium Study in Untreated Mild Hypertension ..... 309 T. MORGAN, and C. NOWSON The Salt Balance in Asia 319 Y. YAMORI Dietary Electrolytes and Hypertension: An Epidemiologic Perspective ........ 329 F.C. LUFT, W.R. HARLAN, and L.C. HARLAN X Table of Contents International Symposium on Electrolytes, Volume Homeostasis and Hypertension: Panel Discussion ........................................... 339 F.C. LUFT Appendix 345 Subject Index ................................................................... 361 List of Contributors BABA, K. Dept. of Internal Medicine, Medical College of Ohio, Toledo, Ohio, USA BAK,A.A.A. Dept. of Epidemiology, Erasmus Univ. Medical School, PO Box 1738, Rotterdam, The Netherlands BALMES,R. Med. Abt., Krankenhaus der Barmherzigen Bruder, Marschallgasse 12, A-8020 Graz, Austria BARENBROCK, M. Med. Abt., Krankenhaus der Barmherzigen Bruder, Marschallgasse 12, A-8020 Graz, Austria BARLOW, G.K. Dept. of Medicine, Cardiovascular Genetics Center, 410 Chipeta Way, Research Park, Salt Lake City, Utah 84108, USA BARNA,!' First Dept. of Medicine, Semmelweis Univ. Medical School, H-1083 Budapest, Hungary BARTH, W. Akademie der Wissenschaften der DDR, Zentralinstitut fUr Herz-und Kreislaufforschung, Wiltbergstr. 50, DDR-115 Berlin-Buch, DDR BERRY, T.D. Dept. of Medicine, Cardiovascular Genetics Center, 410 Chip eta Way, Research Park, Salt Lake City, Utah 84108, USA BLEHSCHMIDT, N. Dept. of Medicine, West Virginia University School of Medicine, Morgantown, WN 26506, USA BUKOSKI, R.D. The Oregon Health Sciences University, Dept. of Medicine, 3181 S.W. Sam Jackson Park Road, Portland, Oregon 97201, USA
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